The proposed study will examine the extent, correlates and consequences of spreading administrative constraints and financial incentives affecting psychiatrists' practices in the United States. We hypothesize that the growth of incentives and controls results from ongoing changes in negotiations between psychiatrists and the insurers or hospitals with which they are affiliated. Factors that reduce physicians' bargaining power encourage the spread of these external influences. The relative bargaining position of psychiatrists will be related to the demand for and supply of their services, the competitiveness of the market for mental health care as well as the structure of psychiatrists' practices and government policies that affect the competitiveness and profitability of markets for psychiatric care. The study will estimate a set of regression models to determine the relative importance of each of these factors. The study will also measure the consequences of these interventions in terms practice patterns -- the diagnostic and payer mix of psychiatrists' practices, their willingness to provide care at reduced or no charge, their willingness to accept chronically ill patient or referrals from community agencies, as well as the economics of their private practices. It will thus provide one of the first empirical studies of contemporary attempts to manage physician practices, both inside and outside of so-called "managed-care" settings. The primary data source for the study will be a survey of 2500 psychiatrists conducted by the American Psychiatric Association (APA) in 1988. Their responses to this survey will be combined with data from secondary sources describing the characteristics of the community and local health care markets where these psychiatrists practice. Additional information will be included about state policies -- including mandated insurance benefits for mental health care, freedom of choice laws allowing non-psychiatrists to bill for psychiatric services, and certificate-of-need regulations that restrict entry by new providers. Analysis of this data should reveal important information about (a) the nature of psychiatric care in organized practice settings, (b) the behavior of hospitals and insurance plans that are becoming increasingly active in shaping that care, and (c) the potential for influencing the spread and consequences of practice management through government intervention.